Development of acute sacroiliitis due to the use of oral isotretinoin in patients with acne vulgaris: Four case presentations

Sakroiliit, sakroiliak eklemin inflamasyonu olup en sık ankilozan spondilit hastalarında görülür. Akut sakroiliit ise altta yatan enfeksiyöz, romatolojik, neoplastik veya ilaç-ilişkili nedenlere bağlı olarak daha nadir izlenir. Akne vulgaris, pilosebase üniteyi etkileyen kronik inflamatuar bir hastalıktır. Oral izotretinoin şiddetli nodülokistik ve sistemik antibiyotik tedavilerine dirençli aknede verilen sentetik A vitamini türevidir. Akne vulgarisi olan hastalarda oral izotretinoin kullanımına bağlı az sayıda akut sakroiliit olgusu rapor edilmiştir. Izotretinoin kullanımına bağlı sakroiliit gelişiminin mekanizması tam olarak bilinmemektedir. Erken tanı sonrasında ilacın kesilmesi, nonsteroid antiinflamatuar tedavi, fizik tedavi ve egzersiz programı ile hastalık sınırlanmakta ve 6 ay içinde hastalar normal fonksiyonlarına kavuşmaktadır. Biz bu çalışmamızda, oral izotretinoin kullanımına bağlı gelişen akne vulgarisli 4 akut sakroiliit olgusu sunduk.Sacroiliitis, an inflammation of the sacroiliac joint, is a characteristic finding of ankylosing spondylitis. Acute sacroiliitis has been described relatively uncommonly, and typically featuring the underlying infectious, rheumatic, neoplastic, or drug-related causality. Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit. Oral isotretinoin is a synthetic vitamin A derivative that has been used to treat severe nodulocystic acne and resistant acne to systemic antibiotic therapy. Few cases have been reported about acute sacroiliitis occurrence due to oral isotretionin treatment in patients with acne vulgaris. The mechanism of sacroiliitis owing to the use of oral isotretionin is not clear. The cessation of drug after early diagnosis, nonsteroidal antiinflammatory treatment, physical rehabilitation and exercise programs limit the progression of disease and the patients can reach their normal functions within 6 months. In this study, we present 4 cases of acne vulgaris with acute sacroiliitis caused by oral isotretionin

A Basic Question: Are Patients with Chronic Obstructive Pulmonary Disease Aware of Their Disease?

OBJECTIVES: Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is important for its management, but there are limited data regarding the basic knowledge among patients with COPD. This study aimed to evaluate the basic information and knowledge of patients who were specifically provided with a medical exemption certificate for COPD

The first successful desensitization protocol in exenatide allergy: a case report

Abstract Background Glucagon-like peptide-1 (GLP-1) receptor agonists are important treatment options in obese patients with type 2 diabetes. To date, few immediate allergic reactions due to GLP-1 receptor agonists were reported. One report revealed that a patient with a level 1 anaphylaxis according to Brighton Criteria due to an exendin based GLP-1 receptor agonist was able to tolerate liraglutide (Human GLP-1 analogue), the alternative GLP-1 receptor agonist. Since exenatide is the only available GLP-1 receptor agonist covered by insurance in Turkey, a drug desensitization protocol, the only therapeutic method in hypersensitivity reactions used in case of absence of an alternative drug, was considered. Here, we report a successful desensitization protocol for the first time in two obese diabetic patients with an immediate hypersensitivity to exenatide. Case presentation The first patient was a 47 year-old female. She was referred to our outpatient allergy clinic because of a generalized urticaria developed within minutes after the last dose, following a week of an exenatide BID 5 mcg/20 mcl treatment. Although the reaction was sudden onset, it did not meet the Brighton Criteria of anaphylaxis. The second patient was a 46 year-old female. She had a large local immediate injection site reaction that appeared 15 min following an exenatide BID 5 mcg/20 mcl injection. The injection site reaction was not accompanied by a systemic allergic reaction. We performed desensitization with exenatide to two patients who need GLP-1 receptor agonist treatment. Protocol was completed in 7 steps in approximately 3 h, with the aim of reaching the daily dosage of exenatide. Throughout this process, we observed that both cases tolerated the protocol without any complaints or complications. Following the protocol, the patients safely tolerated the treatment for 3 months. Conclusions We present the first successful desensitization protocol to exenatide in both local and/or systemic immediate hypersensitivity reactions and indicate the importance of desensitization in patients who do not have alternative therapies

Assessment of right ventricular geometry and mechanics in chronic obstructive pulmonary disease patients living at high altitude

Degree of increase in pulmonary artery pressure (PAP) and adaptive responses in right ventricular morphology and mechanics play an important role in the prognosis of chronic obstructive pulmonary disease (COPD) patients. Three dimensional echocardiography and deformation imaging are recent advancements in echocardiography that allow more through assessment of right ventricle. We aimed to investigate right ventricular geometry and mechanics in a stable COPD population living at moderately high altitude. A total of 26 stable COPD patients with variable disease severity were included to this study. Pulmonary function tests, six minutes walking test (6MWT) and two- and three-dimensional echocardiography were performed for evaluation and data collection. Both systolic (43.06 +/- A 11.79 mmHg) and mean (33.38 +/- A 9.75 mmHg) PAPs were significantly higher in COPD patients compared to controls (p < 0.05, p < 0.001; respectively). Right ventricular volumes were similar between groups, although right ventricular free wall thickness was significantly increased in COPD group. The number of subjects with a sub-normal (< 40 %) right ventricular ejection fraction was significantly higher in COPD group (45.8 vs. 17.4 %, p < 0.05), and the mean right ventricular strain was significantly lower (-21.05 +/- A 3.80 vs. -24.14 +/- A 5.37; p < 0.05). Only mean PAP and body surface area were found as independent predictors for 6MWT distance. Increased PAP and reduced right ventricular contractility were found in COPD patients living at moderately high altitude, although right ventricular volumes were normal. Similar findings can be expected in other COPD patients with high PAP, since these findings probably represents the effect of increased PAP on right ventricular mechanics

Impact of COVID-19 pandemic on the course of refractory chronic spontaneous urticaria under omalizumab treatment

© 2022 Sociedade Brasileira de DermatologiaBackground: The course of chronic spontaneous urticaria (CSU) can be influenced by infections, depression, and stress. Objective: Our aim was to investigate the impact of the COVID-19 pandemic on the course of refractory CSU together with patient adherence to omalizumab and treatment adjustments. Methods: Urticaria Activity Score (UAS7) was used to assess disease activity. Fear of COVID-19 Scale (FC-19s), and Depression Anxiety Stress Scale (DASS-21s) were performed to assess mental health status. All scales were performed during the Quarantine Period (QP) and Return to the Normal Period (RTNP). UAS7 Before Pandemic (BP) was recorded from the patients medical records. Results: The authors evaluated 104 omalizumab-receiving CSU patients. UAS7 scores during QP were significantly higher than those in RTNP and BP (p < 0.01). DASS-21 and FC-19 scores were significantly higher during QP compared to RTNP (p < 0.01). Nineteen (18.2%) patients ceased omalizumab, 9 patients prolonged the intervals between subsequent doses during the pandemic. UAS7 scores in QP were significantly higher in patients who ceased omalizumab than in those who continued (p < 0.001). Among patients who continued omalizumab, 22.4% had an increase in urticaria activity and higher FC-19 scores in comparison with those with stable disease activity (p = 0.008). Study limitations: The small sample size of patients with prolonged intervals of omalizumab and the lack of mental health evaluation with the same tools prior to the study. Conclusion: Fear induced by COVID-19 can determine an increase in disease activity. Therefore, patients on omalizumab should continue their treatment and prolonged interval without omalizumab can be considered in patients with good urticaria control

Calculated globulin is clinically useful as a screening test for antibody deficiency in Turkish adult patients

Introduction: Heterogeneous clinical features of antibody deficiency (AD) may cause diagnostic delays. Calculated globulin (CG) (total protein minus albumin) has been proposed as a screening test to prevent morbidity due to diagnostic delays in AD. Our aim was to validate CG as a screening test for AD in Turkish adult patients by comparing its role with gamma globulin analysis in protein electrophoresis. Methods: Fifty serum samples were randomly collected for each level of CG from 15 to 25 g/L and tested for serum IgG, IgA, IgM levels and protein electrophoresis. Cut-off values predicting low IgG levels were calculated for electrophoretically determined gamma globulin and CG. Additionally, the data of 47 patients followed up in our clinic with a diagnosis of primary antibody deficiency (PAD) were retrospectively analyzed. Results: A total of 550 adult patients were included in the study. The CG value predicting patients with IgG <6 g/L as a screening test was determined as <20 g/L with 83.8% sensitivity and 74.9% specificity. The gamma globulin value which predicted patients with the same IgG value of 89.0% sensitivity and 89.4% specificity was determined as <7 g/L. In the retrospective analysis, 37 of 47 patients (78.7%) with PAD had a CG value of <20 g/L at the time of the diagnosis and all 13 patients (100%) whose gamma globulin values were measured at the time of the diagnosis had a gamma globulin value of <7 g/L. Conclusion: The determined CG cut-off value of <20 g/L can be used as a screening test in Turkish adult patients